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Health care reform: States may test HHS power

If the Supreme Court upholds the health care reform law, states may still fight back. | John Shinkle/POLITICO

The stakes are so high, said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities, that the idea of a state stonewalling the law after it’s upheld by the Supreme Court is “far-fetched across the board.”

A more realistic scenario might be for a state to do just enough to avoid triggering HHS enforcement action, but not enough to fulfill all the legal requirements. And that’s what consumer advocates expect in Wisconsin if Gov. Scott Walker survives a recall election.

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Robert Kraig of Citizen Action of Wisconsin said he anticipates Walker will “pursue a nullification strategy” by dragging his feet on integrating with Medicaid and stalling for time by creating a health exchange that doesn’t meet the law’s requirements.

Whether a state tries outright civil disobedience or subtler stonewalling, HHS may have trouble using its powers to bring it into line, say health law experts.

Cutting off Medicaid dollars would be both bad policy and bad politics. And usurping state powers would open HHS to massive accusations of a “federal takeover,” which could further inflame political attacks on the health care reform law.

“Even if they could do that, I don’t think they would,” said Cheryl Smith of Leavitt Partners, an exchange consultant that is working with policymakers in several states that would prefer that the Supreme Court strike down the law.

Smith is skeptical that HHS even has enough personnel to take over a recalcitrant state’s insurance regulation on top of coaxing along states that are not in outright violation of the law. She expects only a handful of states to be fully compliant with the health care law when the exchanges open for business in 2014, and the department’s resources will be stretched thin.

But even if most states comply, it seems likely that at least a couple Republican lawmakers are going to test the department, suggested former Virginia Rep. Tom Davis, a moderate who abandoned a Senate bid in the face of stiff conservative opposition.

Davis noted that pragmatic Republicans, who have argued that their states should do exchange planning in case they lose in the Supreme Court, have already attracted challengers from the right. If the law is upheld, officials who cooperate could face primaries from those who promise to block an exchange at all costs.

Opposition to health care reform has become such a conservative shibboleth that Davis predicted, “You’re going to get some demagoguery.”

Officials in some states that are leading the opposition to the Affordable Care Act, such as Louisiana and Florida, have said they will comply with the law if they lose in the Supreme Court.

But Virginia Attorney General Ken Cuccinelli declined to rule out the possibility of civil disobedience.

“It would be contrary to the law, yes,” he said last week, but added, “It’s not like there’s criminal penalties out there. It becomes a power struggle.”

That's Sebelius problem........States are dropping ....out of the LINE..... that she and Obama drew.

They don't like what they saw in Sebelius and OTHER politicians abdicating their Constitutional OATH.

"I do solemnly swear (or affirm) that I will faithfully execute the office of (Insert name) of the United States, and will to the best of my ability, preserve, protect and defend the Constitution of the United States."

"shall be bound by Oath or Affirmation to support the Constitution."

The Senators and Representatives before mentioned, and the Members of the several State Legislatures, and all executive and judicial Officers, both of the United States and of the several States, shall be bound by Oath or Affirmation, to support this Constitution; but no religious Test shall ever be required as a Qualification to any Office or public Trust under the United States.

IF THEY WOULD READ THE CONTITUTION "STATES RIGHT" TRUMPS THE FED...OMG..STAND YOUR GROUND !!! YOU SEE WHEN YOU ELECT TERRIOST TO OFFICE THEY DON'T GIVE A CRAP ABOUT THE LAW OF THE LAND "WE THE PEOPLE" FOLKS, SCREW THE FED GOV'T THEY ARE SUPPOSE TO PROTECT OUR COUNTRY NOT DICTATE !!

IF THEY WOULD READ THE CONTITUTION "STATES RIGHT" TRUMPS THE FED...OMG..STAND YOUR GROUND !!! YOU SEE WHEN YOU ELECT TERRIOST TO OFFICE THEY DON'T GIVE A CRAP ABOUT THE LAW OF THE LAND "WE THE PEOPLE" FOLKS, SCREW THE FED GOV'T THEY ARE SUPPOSE TO PROTECT OUR COUNTRY NOT DICTATE !!

Health care reform: States will challenge the HHS power, but in a broken system since the previous administration, everybody is up to deny it when greed is on the plate. The needs and livelihood does not mean anything the power of greed.

Hey Simms, since the Civil War, Federal Law has trumped State Law in all cases.

And I am sure that there would be other ways for a pro-ACA administration to gently nudge states into cooperation. You know, like the HHS could get the Transportation department to stop sending highway fund money to that state.

But the bottom line is this. At some point, people are going to get fed up with politicians that are refusing to implement a system designed to make health care available, especially when these same politicians refuse to offer any solution of their own.

The sooner we get rid of this atrocity of a health care bill the better. Obamacare is a poorly crafted piece of legislation which in no way lowers costs as claimed, instead adding insult to injury! Have you read it or talked to someone who has? Your doctor perhaps? Even before the full implementation of Obamacare, doctors are retiring and fleeing in droves. Bad for patients. Some smaller hospitals are closing. Bad for patients. Employers can't afford the more expensive insurance required under Obamacare and aren't expanding if not shrinking, bad for jobs and patients. Insurance companies are raising premiums because of Obamacare's expensive requirements: bad for patients. Bad for jobs if those companies fold. Even the public option isn't attractive: I've been on public and private and there is NO comparison in quality of care. Bad for patients. And of course, the costs will be astronomically higher than projected like every other government program, which taxpayers get to cover. Bad for everyone! In fact, if you look at the numbers beyond the 10 year CBO requirement, Obamacare will never be solvent again. Instead adding trillions to our enormous deficit annually. The deficit already exceeds the GDP and our debt per capity exceeds that of Greece; we can't afford Obamacare or any other increase in spending.

The current law also says that come Aug 1, 2012, Medicare will no longer reimburse individuals involved in care, but give out a certain amount based solely upon diagnosis. This amount of money would not change based upon severity of the disease, length of stay, extra testing, etc. That means all doctors (and the hospital) will have to divide up the money in some way hopefully reflective of care given, and the result is projected to halve doctors' pay to a little over $100k. This might not be a big deal were medical education so long and expensive and malpractice so high. But Obamacare lacks any tort reform, so medical costs will continue to be high so that doctors can assure lawyers in court that they did everything possible to care for their patients, including unnecessary expensive tests and labs. Not that I blame them for not wanting to get their butts sued off. I blame Obamacare for leaving out changes to the biggest cost driver in medicine, but what do you expect from a bunch of lawyers?

If this is news, consider your sources. You've got to read both sides because both sides leave stuff out.

Some civil disobedience is long overdue. Time to take back power from our federal government.

Occupy Obamacare. Why should the administration worry. After all, if some states don't comply, with this ever so popular program, can't Obama count on those who are in charge being voted out in the next election. You know, the overwhelming majority who are in favor of Obamacare will see to it that they are replaced...............................................won't they?